Clomid and insurance question

abs711

Good Morning Ladies!  I was just reading up on Clomid (as I was suppose to start it this month but waited to long to call the doctor so now I will have to wait until next month).  But as I was reading I came across a website that more or less states that if you take Clomid you will have problems with your insurance company covering you.  It also says that if you have to change insurance companies other companys won't take you on.  Has anyone heard of this?  I do not understand why infertility is like the plague - I mean really it is so common these days!  I really hope this is not true. 

Mrs.BigCountry

Every insurance company is different, but here's my story.  I took Clomid for three cycles last year.  I was on my company's insurance (BCBS).  I got laid off in September.  I tried to get my own insurance -- to avoid the high COBRA costs and the high cost of adding me to my husband's insurance.  I was denied coverage because I had taken Clomid.  So, I had to COBRA.

 

In January, my husband became a partner in his company.  One of the perks was free family insurance coverage.  So, I dropped my COBRA and became insured through his company (QualChoice).  Because I had a certificate of coverage, I had no trouble with QualChoice.

 

So, with my experience, I think you would only have trouble getting coverage on your own.  I was told by Golden Rule (part of UHC) that they denied my coverage b/c I took Clomid.  And, women who take fertility drugs can become pregnant with more than one baby.  And this might result in having premies.  Blah, blah, blah.

Temp616379875002458

Hmm. I have been on Clomid for 6 cycles now.  Insurance paid for it the first two months but I think they were just confused - I live in a no mandate insurance state so we have no mandatory fertility coverage in the state (although some private insurers do offer these benefits in really rich benefit packages). .   I haven't had experience changing companies after starting Clomid, but I wouldn't expect much from insurers.  (No offense to anyone employed by an insurer, but from experience, I think it is best for me to keep expectations low.)

I am intentionally staying with my current job (although desperately ready to move on) because of my current insurance coverage.

Kelly0615

I suppose it depends on you insurance, but all of my Clomid prescriptions were covered. In fact everything (office visits, testing, meds) has been covered for my RE except the actual IUI procedure and my HcG trigger.

You can either check with your HR benefits dept (if you are comfortable) or call your insurance company. They can tell you what your coverage would be. 

MrsEzStar

It's my understanding that you can get coverage through your employer or spouses employer with no problems.  They will deny you coverage until you have had your tubes tied or something like if you are trying to purchase your own insurance. 

Basically Insurance companies suck!!!!!

abs711

Hmmm...  Thanks for the thoughts.  I am not to worried about my current insurance company I am worried about future companies.  I guess I will call my current and see if they have anything to add.  I am just worried that if I take it now and get a new job in a year or two that all of a sudden I wont be able to get insurance.

lax15bsu

abs - The only reason you would have any trouble getting health insurance in the future due to Clomid is if you apply for an individual policy.  The individual market is picky and can pick and choose which conditions they will cover and which they won't.  Just so happens that anyone taking Clomid will most likely be denied individual coverage due to the risks of multiples in pregnancy. 

 HOWEVER - if you get another job that has health insurance, you are guaranteed coverage.  And if you move straight from one job to the next, and have no gaps in insurance coverage, then the new insurance has to cover all pre-existing conditions too. 

 Now, the new insurance company may not have Clomid in their list of formulary drugs.  Meaning you might have to pay out-of-pocket the retail price.  And some states don't mandate the insurance company has to cover fertility stuff, so you'll have to check that your new job's policy covers fertility diagnostics and treatments. 

The key to everything is to have continuous coverage.  As long as you have no gaps of more than 63 days in your insurance coverage, then the new insurance company can't deny any pre-existing conditions, and they couldn't deny you coverage just because you took Clomid 2 yrs ago.  Employer sponsored coverage is guaranteed issue - meaning you can't be denied due to any medical conditions. 

I work in a health insurance agency, so I know my stuff.  Let me know if you have any other questions!

abs711

Great info THANKS!!!  I was getting totally worried.  What if I say left my job and started a new one that I had to be at for 90 days before insurance kicked in.  Do you think if I were on cobra for the 90 days I would be ok?

 Thanks again!  I was getting really worried about this.  It is hard enough to convince my Hubby to go along with it to have the insurance Companies take hsis side would stink.